Healthcare Provider Details

I. General information

NPI: 1790877033
Provider Name (Legal Business Name): BEVERLY L MCMILLAN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST MAIL CODE 118
DENVER CO
80220-3808
US

IV. Provider business mailing address

1130 MONACO PKWY
DENVER CO
80220-4663
US

V. Phone/Fax

Practice location:
  • Phone: 303-370-7511
  • Fax: 303-370-7512
Mailing address:
  • Phone: 720-941-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122668
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: